Hard News: A Real Alternative
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The Kim Hill - Charlotte Paul interview and reading the McCredie et al 2008 Lancet Oncology paper with clearer presentation of the treatments and updated analysis lead me to regret casting aspersions on the Cartwright inquiry. Whatever Bryder's views - and I'm sure they are finely nuanced - my
Extending that just a little, the implication is that the inquiry was not about establishing the truth, that Silvia Cartwright did what was expected of her by the influential, did it well. And then went on to higher judicial honours and the Governor-Generalship.
was a gross extension, uncalled for. I farted in church: thank you all for politely ignoring it, as one should.
There are oddities on the matter of the "experiment" and its presentation. Paul was very specific that Green progressively (ie in advance, as opposed to retrospectively) chose a portion of patients with diagnosed CIS (CIN3) for monitoring-only "treatment", in fact she said on the basis of the day of the week (as a form of randomisation, a detail that might have been worth a "really?" follow-up question).
But the McIndoe et al 1984 paper that was the expose published after Green's retirement and purportedly the basis of the Metro article and inquiry - it says no such thing, and the groups 1 and 2 whose respective outcomes differ so markedly are clearly stated to be established on the basis of normal (negative) smear test results or not after 2 years, that is retospectively. Taking this at face value would seem to be a fair basis for an interpretation that there was no experiment. -
progressively = prospectively, sorry again for my retrogression
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As a general rule, if you've spent an hour typing into a text window on PA System, it is always best to assume that your login could have dropped off, and to just select and copy what you've typed.
It should be better with the upcoming forums upgrade.
The problem in fact was that that I did copypaste and save an early version, then proceeded to add ~45 minutes of revisions which weren't saved.
In fact I found it useful to have to re-summarise my own thoughts, and also force myself to take my own advice on not pre-empting Bryder's book...
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@ChrisW -- I rather wish that there had been a follow-up question on the prospective assignment. I think yo're misinterpreting McIndoe et al., however. I don't get the impression that their study was done with Green's co-operation, so I assume that is why they took a retrospective approach in creating groups. Secondly, even under modern ethics jurisdictions, the requirement to retain study records is for 10 years only. The patient records were clearly kept, but it is entirely possible that Green's records relating to his research were not. Clarification on this would have been good.
Despite that, I still think that the "was there a control group?" is a bit of a red herring. Even if there wasn't one, the study would still qualify as a case series, which is a kind of uncontrolled experiment.
The herald article 'An unfortunate revision' is worth reading. Paul calls Bryder on a couple of misquotes, in terms of what was considered standard treatment in the 60s. It also notes that Bryder was wrong on the number of Clare Matheson's children (her source was Corbett's 1990 newspaper article!).
Also, somewhat in reference to Craig's earlier question, instead of a single cone biopsy that likely would have been the end of it, Matheson had 6 surgeries under general anaesthesia and 44 visits to NWH, had recurrent abnormalities when Green stopped checking her 16 years later, and eventually developed full blown cancer. That doesn't really match up with Bryder's portrayal of that case in the interview (or the book, apparently).
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It might have been better to give independent reviewers a run-up at this one, given the splash made by the two launch interviews.
I understand that, as per standard practice, AUP sent the book out to readers for comment pre-publication. The only NZ academic was a medical expert who helped clarify medical issues. No NZ historians or anyone from the 'other side' of the debate were asked to comment on it - for these matters it was sent to overseas academics with little knowledge of NZ history and this particular part of it.
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But it does seem likely to me that patient practices were considerably improved in the wake of the Cartwright report.
Russell, this is an understatement. In your recent hospital experience, you would have been addressed by name, had procedures explained to you, had to sign consent, and had Health and Disability Commissioner ethical codes and complaints procedures prominently displayed. You would not have had a consultant and medical students discussing your 'case' and proding your unclothed body without them asking you first.
If there was a clinical trial or research project underway in the hospital (and there are lots of these happening all the time) for which you were eligible, you would have had the project explained to you, been given an easy to understand information sheet and told what will happen with the data or tissue (and been reassured that there was no compulsion to join the study and that you could withdraw at any time). You would have to sign consent, and given contact details for any ongoing questions or concerns.
This research project would have been approved by one of the Ministry of Health's regional ethics committees, all of which have significant consumer representation. Any serious adverse effects on patients arising during the research would also have to be reported to them.
This has all happened in the last 20 years as a result of the Cartwright report.
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And not because they would have "happened anyway" - that's surely Bryder's most insulting claim.
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This has all happened in the last 20 years as a result of the Cartwright report.
And has made NZ a *terrible, difficult* place to practice, according to an expat MD commenting on the RadioNZ website. I'm afraid my only response there is a resounding boo-fucking-hoo.
I'm quite interested in the way that there has been a 'feminist false-consciousness' subtext in the way this story has developed. You know, 'back then all those humourless feminists were just *looking* for stuff to be offended by, but we're all beyond that now'.
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The herald article 'An unfortunate revision' is worth reading. Paul calls Bryder on a couple of misquotes, in terms of what was considered standard treatment in the 60s. It also notes that Bryder was wrong on the number of Clare Matheson's children (her source was Corbett's 1990 newspaper article!).
There's a good blog post here comparing the Listener story and Chris Barton's work in the Herald:
He explores what is clearly a difficult issue (both from an emotional point of view and because of the number of years that have passed since so much of this took place) and manages to piece together a compelling story of a doctor who was all too human working in a system that was all too rigid during a time of change.
This is what The Listener should have done. It’s an actual piece of journalism rather than a book review masquerading as such. It asks awkward questions, it has a balance, it has humanity and compassion and at the end I know more than I did when I went in.
Once again The Listener has let down its readers. I see it’s advertising for a deputy editor. That can’t be all the magazine needs.
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The herald article 'An unfortunate revision' is worth reading.
OK, was I the only person who found this frankly embarrasing -
It was the last thing Clare Matheson needed. A new book claiming the "unfortunate experiment" begun in 1966 at National Women's Hospital was neither an experiment, nor unfortunate.
Recovering from major hip surgery which prevented her from attending the funeral of a friend of 40 years, Matheson was already feeling down.
"I'm feeling pretty ratshit anyway and then this, on top of it. I'm not a spring chicken any more." But, at 72, she is still a battler, and still able to have a laugh when she contemplates confronting the book's author, Linda Bryder. "Yes, great idea, says she, shaking in her shoes."
But she is annoyed that 21 years after the inquiry into what happened to Matheson and other women at National Women's, a revisionist history is being proposed.
"I am totally sick to think that the character assassination has started all over again. I'm tired of being accused of being a liar."
Wow... so what the hell does all this have to do with the substance (or otherwise) of Bryder's argument, as opposed to dog-whistling that Bryder's a misogynistic skank beating up on an old, sick (but still feisty) lady?
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BTW, the story is worth reading. Damn shame Chris Barton couldn't have run a blue pencil through the kind of lead I expect from No Idea rather than the alleged newspaper of record.
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I'm quite interested in the way that there has been a 'feminist false-consciousness' subtext in the way this story has developed. You know, 'back then all those humourless feminists were just *looking* for stuff to be offended by, but we're all beyond that now'.
That was perhaps the intention of quoting Bunkle's otherwise irrelevant birth story from Bryder's book. (OTOH, that was a very weird piece of writing. I struggle to believe that even back then, her doctor really took such a leering quasi-sexual joy in performing an epistiotomy without anaesthetic.)
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what the hell does all this have to do with the substance (or otherwise) of Bryder's argument, as opposed to dog-whistling that Bryder's a misogynistic skank beating up on an old, sick (but still feisty) lady?
Barton is a feature writer and therefore used to painting word-pictures of interviewees. This story is a feature in the Saturday edition where that personal description is quite standard.
Seems only fair to humanise one of the other major participants if he is also portraying "a compelling story of a doctor who was all too human", to quote Audent who Russell linked to. It's also a way of showing that time has passed.
Audent also offers:
‘Why’ goes to motive. ‘Why’ is the question nobody wants answered; everything else is biography.
As Danielle notes, the motivation and the current political context seem relevant, even if only to explain the rabid one-sidedness of the Listener. Matheson, Cartwright, Coney and others have been quite deliberately demeaned, and it's part of a larger backlash discourse that is happening largely un-named.
Maybe that's why it seems like a dogwhistle, Craig. But it's not from the mouth you think it is.
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Barton is a feature writer and therefore used to painting word-pictures of interviewees.
And The Herald seems quite fond of reducing complex public policy issues to a 'human interest' sob story where the goodies and baddies are all lined up and clearly labelled, and perhaps we have a right to expect a little better from the alleged paper of record. As I said, Barton's story was worth reading and I fail to see how it was served (let alone improved) by a lead trying to construct a Matheson vs. Bryder cat fight.
Matheson, Cartwright, Coney and others have been quite deliberately demeaned, and it's part of a larger backlash discourse that is happening largely un-named.
Well, Sacha, you've touched on something else that bugged me about that lead. Could you find me a single citation where Bryder has accused Matheson or anyone else of lying to the Cartwright Inquiry? Where I come from, perjury is a rather serious offence -- and so is accusing people of alleging such when they've done no such thing.
It's also a rather useful de-rail to accuse others of speaking in bad faith, as "un-named" agents of some rather shadowy 'larger discourse'. You know, like that feminist-homosexual-leftist agenda Ian Wishart keeps vapouring about, but which has signally failed to bring about the People's Paradise.
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Listener might be worth buying one more time to see what the reaction to last week's cover story is in the Letters section.
(I was determined to keep away from the Listener when it changed a few years ago but I enjoy the arts section. Last week had an interesting article about The Wire.)
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Wow... so what the hell does all this have to do with the substance (or otherwise) of Bryder's argument, as opposed to dog-whistling that Bryder's a misogynistic skank beating up on an old, sick (but still feisty) lady?
Yeah, i guess the Herald could have just skipped the Real Life effects on a woman harmed by the Unfortunate Experiment and whose story forms a big part of the book Bryder's hoping will enhance her reputation. What does she matter, eh Craig?
Bryder hasn't availed herself of primary sources - Matheson, Coney, Bunkle, Cartwright - which doesn't seem historian-like to me. For Example - from the Herald:
"MATHESON wants to ask Bryder where she got her information - especially details about how her tumour was apparently "so small and localised that it was completely obliterated by the radiation".That was news to Matheson, and was not in her medical file. Who, she wondered, had - in breach of the Privacy Act - been discussing minute details of her medical history? But when she tried to contact Bryder, the latter refused to speak to her."
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Craig, "demean" is not a synonym for "lie". And discourse is far more sophisticated than individuals acting with transparent intent.
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Kudos to Hilary for your enlightened, patient responses on this.
The alacrity of some to leap on Bryder's book as the evidence long awaited to prove the UE an hysterical exaggeration by feminists gives me the creeps. I don't want to believe it's happening. And I agree with Danielle and Sacha -
Matheson, Cartwright, Coney and others have been quite deliberately demeaned, and it's part of a larger backlash discourse that is happening largely un-named.
The backlash is about minimising, discrediting, dismissing, marginalising and ridiculing the sort of dissent and free thinking that characterised the 70s-80s. Wouldn't want it to take hold when there's more important things to do like catching up with Australia.
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Just in case. Discourse. A process of conversations, themes and actions, rather than disconnected utterances in a vacuum.
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I should add that there is nothing inherently left or right about that - the dance of politics continues no matter who takes the floor or chooses the music.
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Kerry, thank you. Though argumentative rather than patient. As a history and Women's Studies graduate, I was never going to be neutral on this topic. And disclosure: Phillida was one of my university lecturers many years ago, I'm on an ethics committee, and I've even had a cone biopsy.
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Folks, direct quote from the story:
But she is annoyed that 21 years after the inquiry into what happened to Matheson and other women at National Women's, a revisionist history is being proposed.
"I am totally sick to think that the character assassination has started all over again. I'm tired of being accused of being a liar."
Um, who exactly is calling Matheson a liar? And would it be utterly unreasonable to draw the conclusion that that stick is being squarely pointed at Bryder?
Yeah, i guess the Herald could have just skipped the Real Life effects on a woman harmed by the Unfortunate Experiment and whose story forms a big part of the book Bryder's hoping will enhance her reputation. What does she matter, eh Craig?
Oh, Kerry, it really sucks that people in their 70's have their friends die and major surgery that leave them feeling "kind of rat shit". How that can be blamed on the "Unfortnate Experiment" without getting into wingnut territory is somewhat beyond me. But it is a very useful way to construct a human interest story where the virtuous woman is pitted against the evil tool, and those tiresome complex issues end up trivialised into a girl-on-girl cat fight.
Bryder hasn't availed herself of primary sources - Matheson, Coney, Bunkle, Cartwright - which doesn't seem historian-like to me.
And I've gotten along quite well without any gratuitous and utterly irrelevant and gratuitous blah blah about Bryder's personal life, appearance or the state of her hips.
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Hoo, all quiet and then ...
@ChrisW -- ... I think yo're misinterpreting McIndoe et al., however.
It wasn't so much my interpretation of McIndoe et al 1984 that I was outlining, but the point that their descriptions of treatments and the retrospective basis of their group assignment for analysis of outcomes would, taken at face value by a reader such as Linda Bryder, reasonably lead to the interpretation that there was no experiment. (But it seems they didn't actually describe what happened in design principle or in practice - some may be implicit, but it's substantially obscured.)
It seems to me that this is the key point in the middle of the mess from which there has been such divergence in the overall interpretation and understanding of what happened.
I may be naive, but I reckon poor medical-science communication as well as poor science and pre-Cartwright ethics has a lot to do with this, more than ideologically driven revisionism.
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And not because they would have "happened anyway" - that's surely Bryder's most insulting claim.
Actually, tentatively, I'd like to suggest that that might have been Bryder's most credible claim. That is not to discount the fact that the Cartwright enquiry was clearly the catalyst for NZ's change, and especially for the structures that we now have in place.
However, internationally, the drive to many of these changes had been stimulated by other headline cases. Similarly, the concept of patient-centred healthcare* dates back to at least 1980 I think.New Zealand might have been later to this party if not for Cartwright, but I suspect we would have arrived by now. For example, most medical journals now demand information on the ethics and consent process for publication.
*Incidentally, in the US, republicans may be pinching the term patient-centred healthcare as an opposite to government-centred healthcare!
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As Danielle notes, the motivation and the current political context seem relevant, even if only to explain the rabid one-sidedness of the Listener. Matheson, Cartwright, Coney and others have been quite deliberately demeaned, and it's part of a larger backlash discourse that is happening largely un-named.
But would there have been any acceptable way for Bryder to nuance the accepted wisdom? I suspect, for some people, no. There's just too much invested in it.
I'm quite obviously having second thoughts on Bryder's conclusions, after initially finding her calm, precise manner, and reference to data, persuasive. I'm happy to put my hand up for that.
But if she's going to be bashed for relying on a published account of the number of children Matheson had, it seems a bit unfair for Coney, Bunkle and Cartwright's howler over the "two groups" -- and even given James' useful commentary, it still seems to me a truly terrible mistake -- to be deemed irrelevant.
Perhaps both sides, as James implies, need to be careful about assigning motive.
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